HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: J�,7
RECEIVED
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Building Permit Application NaV ,9 NZI
Planning and Development Services lSt.L Cleo my
Building and Code Regulation Division Commercial Residential P in9
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 I
PERMIT APPLICATION FOR:
Address: S;?�Qrs S �� ��f vh C i y R 3 /9,?p
Property Tax ID#: Cry o ' �W-oc?(7 3- Cvu- Z. Lot No.
Site Plan Name: 14eAl 10t9 v� >' r`�JG,P_, ✓ le{- /0 I Block No.
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Project Name: e-e e l-Q VLQ
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_ Alolc.ce CAn �vv:& -Y z,64- oWcl s/sd4�� ,Jm�fS
New Electrical Meter Second Electrical Meter (Affidavit requirei)
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters ✓Windows%Doors Pond .
—Electric ,Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$- ��(9C9 tJ Utilities: Sewer _Septic ' Building Height:
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Address: 2C�� V �
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City;' �a/'pir%i-Zr i Z . ;-<v "* . Si ateL;.. Addrress: Iq6 /f/
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Zip Code: 3(m4 U Fax: City: State:
Phone No. S-61-W- 047 Zip Code: _?L(q ; i Fax:
E-Mail: PhoneNoo 7�2-2_%-r-93y2
Fill in fee simple Title Holder on next page (if different E-Mail (2 L✓00'4S('C2/pl ca Va t'oO- C pFdf�
from the Owner listed above) State or County License/'6t"� {G/GA7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools, fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County sted on the jobsite before the first inspection. If you intend to obtain financing, consult
with leQderfor an aVorney before commencing work or recording our Notice of Commencement.
Signature of Ow er/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA rr
COUNTY OF
Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization
this a day of tic 20�by
��►,��s-'ria��e� waa�,S
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced L
(Signature of Notar ublic-State of Florida)
,}� : �r�•.• DEANNA GIV_�S
Commission No.� 0 p �r Notary Public-State o`=lorida
d i a �•: ry
1 (Seal) ° °cS f. .ori H Commissior a-I-i C•8.359
r�ss}a44�k(�,iComm, ° My Co Ex,-ires ar 28,2025
A' ��flPt �5°L�(� Bonded through ratiora.rotary Assn.
n0ed
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 Z 21